Transcript home health care - Nutley Public Schools

Unit 1
Health Care Systems
Pages 2 – 18
Introduction
 Health care is one of the largest and fastestgrowing industry in the US
 Expenditures – it is a two billion dollar per day
business and growing
 Over 12 million health care workers in US
 80% of health care work force are women
*Data from obtained from CDC
1.1 Health Care Facilities
 Many different types of facilities
 Employ many types of health care workers
 Individual facilities can vary in:
– Size (individual doctor or complex of doctors facility
for a community or for a county, etc)
– Service provided (general or specific to disease,
age, gender)
– Sources of income (public, private, religious,
nonprofit, government)
 Important to be aware of facilities and type of services
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Types of Health Care Facilities
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Hospitals
Long-term care facilities
Medical offices
Dental offices
Clinics
Optical centers
Emergency care services
Laboratories
Home health care
Hospice agencies
Mental health facilities
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Rehabilitation facilities
Genetic counseling centers
Health Maintenance Organizations
Industrial health care centers
School health services
Government agencies
World Health Organization
U.S. Department of Health and
Human Services
 Occupational Safety and Health
Administration
 Voluntary and nonprofit agencies
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Health Care Facilities
 HOSPITALS
– One of the major types of facilites
– Most hospitals are general hospitals that treat
a wide range of conditions
– Specialty hospitals include:
• Burn, oncology, pediatric, psychiatric, orthopedic,
rehabilitative, government
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Health Care Facilities
 LONG-TERM CARE FACILITIES (LTCs)
– Patients live at facility and are known as residents
• May care for elderly, disabled patients, individuals with
chronic or long-term illnesses
– Extended Care Facilities – rehabilitative care to prepare
patients to return home
– Subacute Units – rehabilitative care for patients recovering
from major illness, intensive medical treatments or surgery
– Independent Living – residents can care for themselves,
but live in the facility. The facility provides residents with
food, housekeeping, transportation and basic medical care
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Health Care Facilities
 MEDICAL OFFICE
– Can offer a variety of services:
• Diagnosis, treatment, exams, lab tests, minor surgery
 CLINICS
– Usually a group of doctors that share a facility and personnel
– Many hospitals have outpatient clinics
 EMERGENCY CARE SERVICES
– Special care for victims of accidents, sudden illness or
patients without a general physician
 LABORATORIES
– Often part of other facilities, but occasionally a separate
facility
– Run blood tests, urine tests, can prepare dentures, etc
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Health Care Facilities
 HOME HEALTH CARE
– Provide care in patient’s home
– Usually used by elderly or disabled patients
 HOSPICE
– Provides care for terminally ill patients with a life
expectancy of less than 6 months
 MENTAL HEALTH FACILITIES
– Treat patients with mental disorders and diseases
• Counseling center, psychiatric hospitals, abuse
treatment centers
 REHABILITATION
– Can be found in hospitals, clinics or a private center
– Can be inpatient or outpatient
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Health Care Facilities
 GENETIC COUNSELING
– Provides individuals or perspective parents information on
their genetic background and disposition to passing on
genetic disorders
• If an individual or couple has a certain likelihood of being
a carrier for a disorder, a blood test will be
recommended to screen for a particular gene
 HEALTH MAINTENANCE ORGANIZATIONS (HMOs)
– Provide total health care directed towards preventative
health care
 INDUSTRIAL HEALTH CARE CENTER
– Occupational health clinics, found in large companies to
provide health care for the employees
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Health Care Facilities
 SCHOOL HEALTH SERVICES
– Provides students with emergency treatment as well as
health education and counseling
 GOVERNMENT AGENCIES
– Provides facilities for government personnel and their
dependents
• Hospitals, psychiatric treatment, rehabilitation, etc
– WORLD HEALTH ORGANIZATION (WHO)
• Sponsored by the United Nations
• Addresses and studies health problems throughout the
world
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Health Care Facilities
 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
(DHHS)
– National agency that deals with US health problems
– NATIONAL INSTITUTE OF HEALTH (NIH) - Researches
diseases
– CENTERS FOR DISEASE CONTROL AND PREVENTION
(CDC) – studies causes, spread and control of diseases in
the population
– FOOD AND DRUG ADMINISTRATION (FDA) – regulates
food and drugs sold to the public
– OCCUPATIONAL SAFETY AND HEALTH
ADMINISTRATION (OSHA) – establishes and enforces job
safety standards
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Health Care Facilities
 NONPROFIT
– Also known as voluntary agencies
– Supported by donations, grants, fundraising, etc
– Usually focuses on one type of disease
• American Cancer Society
• American Red Cross
• March of Dimes
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1:4 Health Insurance Plans
 Health care costs are rising faster than
other costs of living
 Most people rely on health insurance
plans to pay for health care costs
 Without insurance, the cost of an illness
can become a financial disaster
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Insurance Terminology You
Should Know:
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Deductible
Co-insurance
Co-payment
Preferred provider
Monthly fee or premium
Managed care
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Types of Services
 Inpatient services
(e.g., hospitals, long-term care)
 Outpatient services
(e.g., clinics, provider offices)
 Specialty services
(e.g., laboratories, mental health)
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Types of Plans
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Health insurance plans
Health maintenance organizations (HMO)
Preferred provider organizations (PPO)
Medicare
Medicaid
Worker’s Compensation
Managed Care
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Types of Plans
 HEALTH INSURANCE PLAN
– Insurance company pays for some or all of services
(depends on plan, deductible, out-of-pocket expense, etc.)
 HEALTH MAINTENANCE ORGANIZATIONS (HMO)
– Person pays a monthly fee for the membership
– Plan covers regular exams and check-ups
 PREFERRED PROVIDER ORGANIZATIONS (PPO)
– Provided to employees by their company
– The company works with certain health care agencies to
provide the employees with health care at a reduced rate
– Employees can only go to the selected agencies
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Types of Plans
 MEDICARE
– Insurance provided by the government to people over 65 or
disabled persons on Social Security
– Type A coverage – hospital insurance, extended care or
home care
– Type B coverage – medical insurance, doctor services,
therapy
– Covers 80% of medical bills
 MEDICAID
– Government provided medical assistance program
– Operated on a state level, benefits vary from state to state
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Types of Plans
 WORKER’S COMPENSATION
– Health insurance for people injured on the job
 MANAGED CARE
– One approach to health care in response to
the rising costs
– Insurance covers wellness exams and checkups, but need to prove the necessity
– Need referrals to see specialty doctors
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Summary
 Health insurance plans do not solve all the
problems of health care costs
 Do help many people pay for all or
part of cost
 Important for individuals to understand
what plan covers
 Also need understanding of co-insurance
and other restrictions plan may have
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1:5 Organizational Structure
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Line of authority or chain of command
Indicates areas of responsibility
Goal: most efficient operation of facility
Complex or simple structure determined by size
and needs of organization
 To follow proper channels of communication,
workers must take problems, reports, and
questions to their immediate supervisor
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1:6 History of Health Care
 Beliefs and Developments
– Beliefs about health care and cause of disease
has changed greatly from ancient times
– This has also caused drastic changes in the
treatment of patients
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Future of Health Care
Questions you should be able to answer:
 When did most of the significant changes
in health care occur?
 Why were the greatest advances made in
this time period?
 What are some possibilities for the future
of health care?
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1:7 Trends in Health Care
 Changes in Health Care
– Many events lead to changes in health care
– Changes in health care are inevitable and
occur rapidly
– Health care workers must be flexible
to face and keep pace with
the rapid changes
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Some Current Issues
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Cost containment
Home health care
Geriatric care
Wellness
Alternative and complementary
health care
 National health care plans
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Cost Containment
 Purpose: control the rising cost of health
care and achieve maximum benefit for
every dollar spent
 Necessity: costs increasing with
technological advances, improved survival
rates, aging population, and lawsuits
 Issues: need to keep high quality of care,
workers can decrease costs, consumers
can decrease their own health care costs
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Cost Containment Methods
 Diagnostic related groups (DRGs)
– Patients with certain diagnoses put into a payment group
– Agency sets limit of amount to be spent on care
• If care is below the limit, agency keeps the money
• If care costs are above the limit, agency is responsible
 Combination of services
 Outpatient services
 Mass or bulk purchasing
 Early intervention and preventive services
 Energy conservation
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Home Health Care
 Industry grew rapidly when DRGs initiated
 Services provided in patient’s home
 Visits must be pre-authorized by insurance agency
(unless private pay)
 Often necessary to teach family members to perform
care since visits are limited
 Emphasis on cost containment also applies to Home
Health
– Allows for shorter hospital stays
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Geriatric Care
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Care for the elderly
Percentage of elderly population growing
Need for more facilities
Omnibus Budget Reconciliation Act (OBRA)
– Requires states to establish geriatric care,
continuing education for staff, evaluation and
retraining of staff
– Wellness of patient is monitored
• Physical, emotional, social, mental, spiritual wellness
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Wellness
 State of optimal health
 Increase awareness of maintaining health
and preventing disease
 Emphasis on preventative measures
 Different facilities will develop to meet
needs of wellness emphasis
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Holistic Health
 Treat the whole body, mind, and spirit
 Each person is unique with different needs
 Use many methods of diagnosis
and treatment
 Emphasis on protection and restoration
 Promote body’s natural healing processes
 Patient responsible for choosing care and
worker respects the choice
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Alternative and Complementary
Methods of Treatment
 Increasingly used to replace or
supplement traditional medical treatment
 Holistic approach: belief that the effect on
one part effects the whole person
 Based on belief that the person has a life
force or energy that can be used in the
healing process
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Alternative and Complementary
Methods of Treatment
 May vary by cultural values or beliefs
 Often less expensive than
traditional treatments
 Nonjudgmental attitude is essential –
patients have right to choose treatment
 Increased use requires increased
awareness by health care workers
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Types of Practitioners
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Ayurvedic
Chinese medicine
Chiropractors
Homeopaths
Hypnotists
Naturopaths
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Office of Alternative Medicine
(OAM)
 Established in 1992 at the National
Institutes of Health (federal government)
 Purpose: research therapies and establish
standards of quality care
 Many states have passed laws
 Know your state’s law regarding the legal
requirements of alternative therapies
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National Health Care Plan
 Goal: All Americans have health coverage
 Various plan proposals
– Federal government pays for health care,
money would come from taxes
– Health care cooperatives – consumer
purchases health care at a lower cost
– Managed care – employers provide coverage,
government provides coverage for poor
 What are some potential problems?
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Summary
 Health care has changed and will continue
to change
 Workers must be constantly aware of
changes that occur
 Workers must make every attempt to learn
about trends
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